PREVALENCE, INCIDENCE AND RISK FACTORS OF ERECTILE DYSFUNCTION IN MALES WITH TYPE 1 DIABETES ENROLLED IN THE PITTSBURGH EPIDEMIOLOGY OF DIABETES COMPLICATIONS STUDY (EDC) (1986-2007)

Objective: To: 1)determine the prevalence and incidence of ED in males with T1D enrolled in the Pittsburgh Epidemiology of Diabetes Complication (EDC) study from 1986 to 2007; 2)identify risk factors for development of ED; 3)identify the development of ED in relation to other markers of neuropathy; and, 4) determine behavioral and cognitive risk factors associated with the development of ED. Design: The EDC was a cohort study of 333 males with T1D: mean age of 27.53years (SD±7.8, range 8.5-47.4); 331 Caucasians and 2 African Americans; and, duration of diabetes of 19.6years (SD±7.5, range 7.7-37.4). Age-specific ED prevalence was determined from baseline (1986-1988) while age-specific incidence was determined from longitudinal data (1988-2007). Results: Prevalence rate was 10.4 %. Thirty-one had ED: mean age of 35.8years (SD±5.3, range 22.9-44.8) and mean duration of diabetes 26.9years (SD±5.9, range 8.1-37.4). Males with prevalent ED did not statistically differ from males without ED in metabolic control (HbA1), education, income, or the current use of ACE or lipid lowering medications. Associated risk factors for the 31 prevalent cases included; CDSP, HDL and BDI score. Incidence rate was 17.78 % (n=54) from 1989-2007 with a mean age of 40.61years (SD±5.9, range 26.7-60.8) and mean duration of diabetes of 32.54years (SD±5.88, range 20.9-51-9). Mean HbA1 was 10.68% (SD±2.19). Associated risk factors for the 54 incident cases included; CDSP, nonHDL cholesterol, and BDI score. E/I Ratio was significant (p<.01) at the time of the event, but not in the preceding event cycle (p=.18). CDSP was significant (p<.01) in the preceding cycle to ED development and at the time of event (p<.01). For the repeated measure analysis, CDSP was significant in the preceding cycle to the ED development but not at the time of the event. The following differences were found between those with and without ED: knowledge of diabetes (p=.04); self-management (p=.10); and, perception of severity (p=.08). However no significant difference was found between the two groups for self-efficacy. CONCLUSION: CDSP, HDL, nonHDL and total BDI score were risk factors for development of ED in males with T1D. Therefore, these should be assessed for frequently in males with T1D

Automated hippocampal segmentation in 3D MRI using random undersampling with boosting algorithm

The automated identification of brain structure in Magnetic Resonance Imaging is very important both in neuroscience research and as a possible clinical diagnostic tool. In this study, a novel strategy for fully automated hippocampal segmentation in MRI is presented. It is based on a supervised algorithm, called RUSBoost, which combines data random undersampling with a boosting algorithm. RUSBoost is an algorithm specifically designed for imbalanced classification, suitable for large data sets because it uses random undersampling of the majority class. The RUSBoost performances were compared with those of ADABoost, Random Forest and the publicly available brain segmentation package, FreeSurfer. This study was conducted on a data set of 50 T1-weighted structural brain images. The RUSBoost-based segmentation tool achieved the best results with a Dice’s index of (Formula presented.) (Formula presented.) for the left (right) brain hemisphere. An independent data set of 50 T1-weighted structural brain scans was used for an independent validation of the fully trained strategies. Again the RUSBoost segmentations compared favorably with manual segmentations with the highest performances among the four tools. Moreover, the Pearson correlation coefficient between hippocampal volumes computed by manual and RUSBoost segmentations was 0.83 (0.82) for left (right) side, statistically significant, and higher than those computed by Adaboost, Random Forest and FreeSurfer. The proposed method may be suitable for accurate, robust and statistically significant segmentations of hippocampi

Does the distance to the cancer center affect psycho-oncological care and emergency visits of patients with IDH wild-type gliomas? A retrospective study

Background Malignant isocitrate dehydrogenase wild-type (IDHwt) gliomas impose a high symptomatic and psychological burden. Wide distances from patients’ homes to cancer centers may affect the delivery of psycho-oncological care. Here, we investigated, in a large brain tumor center with a rural outreach, the initiation of psycho-oncological care depending on spatial distance and impact of psycho-oncological care on emergency visits. Methods Electronic patient charts, the regional tumor registry, and interviews with the primary care physicians were used to investigate clinical data, psycho-oncological care, and emergency unit visits. Interrelations with socio-demographic, clinical, and treatment aspects were investigated using univariable and multivariable binary logistic regression analysis and the Pearson’s Chi-square test. Results Of 491, 229 adult patients of this retrospective cohort fulfilled the inclusion criteria for analysis. During the last three months of their lives, 48.9% received at least one psycho-oncological consultation, and 37.1% visited the emergency unit at least once. The distance from the cancer center did neither affect the initiation of psycho-oncological care nor the rate of emergency unit visits. Receiving psycho-oncological care did not correlate with the frequency of emergency unit visits in the last three months of life. Conclusion We conclude that the distance of IDHwt glioma patients’ homes from their cancer center, even in a rural area, does not significantly influence the rate of psycho-oncological care

Multispectral brain morphometry in Tourette syndrome persisting into adulthood

Tourette syndrome is a childhood-onset neuropsychiatric disorder with a high prevalence of attention deficit hyperactivity and obsessive-compulsive disorder co-morbidities. Structural changes have been found in frontal cortex and striatum in children and adolescents. A limited number of morphometric studies in Tourette syndrome persisting into adulthood suggest ongoing structural alterations affecting frontostriatal circuits. Using cortical thickness estimation and voxel-based analysis of T1- and diffusion-weighted structural magnetic resonance images, we examined 40 adults with Tourette syndrome in comparison with 40 age- and gender-matched healthy controls. Patients with Tourette syndrome showed relative grey matter volume reduction in orbitofrontal, anterior cingulate and ventrolateral prefrontal cortices bilaterally. Cortical thinning extended into the limbic mesial temporal lobe. The grey matter changes were modulated additionally by the presence of co-morbidities and symptom severity. Prefrontal cortical thickness reduction correlated negatively with tic severity, while volume increase in primary somatosensory cortex depended on the intensity of premonitory sensations. Orbitofrontal cortex volume changes were further associated with abnormal water diffusivity within grey matter. White matter analysis revealed changes in fibre coherence in patients with Tourette syndrome within anterior parts of the corpus callosum. The severity of motor tics and premonitory urges had an impact on the integrity of tracts corresponding to cortico-cortical and cortico-subcortical connections. Our results provide empirical support for a patho-aetiological model of Tourette syndrome based on developmental abnormalities, with perturbation of compensatory systems marking persistence of symptoms into adulthood. We interpret the symptom severity related grey matter volume increase in distinct functional brain areas as evidence of ongoing structural plasticity. The convergence of evidence from volume and water diffusivity imaging strengthens the validity of our findings and attests to the value of a novel multimodal combination of volume and cortical thickness estimations that provides unique and complementary information by exploiting their differential sensitivity to structural change

Human subcortical brain asymmetries in 15,847 people worldwide reveal effects of age and sex

The two hemispheres of the human brain differ functionally and structurally. Despite over a century of research, the extent to which brain asymmetry is influenced by sex, handedness, age, and genetic factors is still controversial. Here we present the largest ever analysis of subcortical brain asymmetries, in a harmonized multi-site study using meta-analysis methods. Volumetric asymmetry of seven subcortical structures was assessed in 15,847 MRI scans from 52 datasets worldwide. There were sex differences in the asymmetry of the globus pallidus and putamen. Heritability estimates, derived from 1170 subjects belonging to 71 extended pedigrees, revealed that additive genetic factors influenced the asymmetry of these two structures and that of the hippocampus and thalamus. Handedness had no detectable effect on subcortical asymmetries, even in this unprecedented sample size, but the asymmetry of the putamen varied with age. Genetic drivers of asymmetry in the hippocampus, thalamus and basal ganglia may affect variability in human cognition, including susceptibility to psychiatric disorders

Less Bone Loss With Maraviroc- Versus Tenofovir-Containing Antiretroviral Therapy in the AIDS Clinical Trials Group A5303 Study

Background. There is a need to prevent or minimize bone loss associated with antiretroviral treatment (ART) initiation. We compared maraviroc (MVC)- to tenofovir disoproxil fumarate (TDF)–containing ART